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Pathology 2 > HIV/AIDS > Flashcards

HIV/AIDS Flashcards

1
Q

Largest group of persons infected with HIV

A

MSM (48%)

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2
Q

__ is a substrate for the Cryptococcal latex agglutination assay

A

Capsular polysaccharide

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3
Q

___ is invaluable to dx of Cryptococcus

A

Capsule

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4
Q

___ T cells play an especially important role in defense against Candida

A

Candida

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5
Q

2 major targets of HIV infection

A

Immune System and CNS

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6
Q

2 microscopic findings in brain of AIDS pt with impaired cognition

A

Microglial nodule, Perivascular macrophages

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7
Q

2 most common viral pulmonary pathogens

A

CMV, herpes

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8
Q

3 AIDS-defining cancers

A

Kaposi Sarcoma, EBV-associated tumors, Cervical cancer

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9
Q

3 cancers seen in AIDS patients

A

Kaposi Sarcoma, Non-hodgkin lymphoma, Cervical cancer

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10
Q

3 M giant cells

A

Multinucleated, Molded nuclei, Marginated native chromatin (HIV Herpes)

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11
Q

3 Viral enzymes in HIV core

A

Protease, RT, Integrase

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12
Q

4 most common bacterial pulmonary pathogens

A

P aeruginosa, Mycobacterium, L pneumophila, L monocytogenes

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13
Q

4 most common fungal pulmonary pathogens

A

P jiroveci, Candida, Aspergillus, Cryptococcus neoformans

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14
Q

Acute Phase is characterized by

A

Nonspecific symptoms, Viremia, Widespread seeding of peripheral lymphoid tissue

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15
Q

AIDS CD4/CD8 ratio

A

.5 to 2

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16
Q

Approx 90% of HIV infections initially are transmitted by

A

R5 strains

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17
Q

Atypic mycobacterium are seen __ in course

A

late

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18
Q

B Cells in AIDS

A

Hypergammaglobulinemia and circulating immune complexes; Polyclonal B cell activation

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19
Q

Bacterial and tubercular infections of lung are more likely at __ levels of CD4

A

higher

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20
Q

Biopsies from enlarged lymph notdes in early stages reveal

A

marked follicular hyperplasia

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21
Q

Biopsy of Herpes nodule shows separation where

A

Dermal-epidermal junction

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22
Q

Brain equivalent of a granuloma

A

Microglial nodule

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23
Q

Candida esophagitis is common among patients with

A

AIDS

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24
Q

CD4 count in beginning of crisis phase

A

Below 500

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25
Q

Cells affect by CMV in lungs

A

Alveolar mac’s, epithelial, endothelial

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26
Q

Cells infected by CMV exhibit

A

Gigantism of entire cell and nucleus

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27
Q

Cells that express CD4

A

Macrophages, DC’s

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28
Q

Clear halo around fungi

A

Capsule –> Cryptococcus

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29
Q

Close to 100% of brain lymphomas are __-related

A

EBV

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30
Q

CMV and M. Avium are uncommon until CD4 levels are

A

below 50

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31
Q

CMV infection in AIDS patients is usually

A

disseminated

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32
Q

Common feature of AIDS secondary neoplasms

A

Tumor cells typically infected by an oncogenic virus

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33
Q

Counts below 500 CD4 are associated with

A

early symptoms

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34
Q

Cryptococcus gelatinous masses expanding the Virchow-Robin spaces

A

Soap-bubble lesions

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35
Q

Despite the presence of spontaneously activated B cells, AIDS patients are unable to

A

mount antibody responses to novel antigens

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36
Q

Drop in viremia to low but detectable levels occurs by about

A

12 weeks after primary exposure

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37
Q

During chronic phase, what are sites of continuous HIV replication and cell destruction

A

Lymph nodes and spleen

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38
Q

During clinical latency period, what proportion of t cells harbor virus

A

small proportion (up to 10%)

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39
Q

During clinical latency phase, CD4 drops to

A

50/cu mm

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40
Q

During primary infection (acute phase), CD4 drops to

A

500/cu mm

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41
Q

Entry of HIV into cells requires

A

CD4 molecule

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42
Q

Even without usual conditions, CDC defines any HIV-infected person with CD4 count less than ___ as having AIDS

A

200

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43
Q

Fever of more than 1 month duration, fatigue, weight loss, diarrhea

A

Crisis phase

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44
Q

First types of cells infected with HIV

A

CD4 T cells in mucosal lymphoid tissue

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45
Q

Function of HIV nef gene

A

Reduces surface expression of CD4 and MHC on infected cells

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46
Q

Function of HIV tat gene

A

Transcription of viral genes

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47
Q

Gatekeepers of HIV infection

A

macrophages

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48
Q

HIV is most likely carried to brain by

A

infected monocytes (R5 types)

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49
Q

HIV viral load during clinical latency phase

A

10,000/ml

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50
Q

HIV viral load during crisis phase

A

10 million/ml

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51
Q

How do most children get AIDS

A

vertical transmission while in utero or newborn

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52
Q

Impaired humoral immunity in AIDS patients renders them susceptible to

A

encapsulated bacteria (S. Pneumoniae, H. Influenzae) that require Ig’s for opsonization and clearance

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53
Q

Important dx clue for C Albicans

A

Pseudohyphae –> Budding yeast cells joined end to end at constrictions

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54
Q

In addition to CD4, what else must bind for infection

A

gp120 must bind CCR5 and CXCR4

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55
Q

In immunosuppressed patients, cryptococcus fungi grow in

A

gelatinous masses w/in the meninges or expand the perivascular Virchow-Robin spaces

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56
Q

Inflammation response after disease progression

A

Sparse and atypical

57
Q

intra-alveolar foamy, pink-staining exudate is characterstic of

A

P Jiroveci

58
Q

Is p17 outside or inside of viral envelope?

A

Inside

59
Q

Kaposi sarcoma is caused by

A

KSHV, HHV-8

60
Q

Kaposi sarcoma is more common in what type of AIDS patients

A

MSM

61
Q

Large cells + basophilic nuclear inclusions w/ halos + granular basophilic cytoplasmic inclusions

A

CMV infection

62
Q

Largest resevoir of T cells in body

A

Mucosal lymphoid tissue

63
Q

Leading contributor to morbidity and mortality in HIV-infected persons

A

Pulmonary diseases

64
Q

Lesion containing spindle cells that share features with endothelial cells and SM cells

A

Kaposi Sarcoma

65
Q

Lymph nodes after disease progression

A

Severe follicular involution and lymphocyte depletion –> Hyalinized –> Burnt-out

66
Q

M. tuberculosis manifests itself __ in course

A

early

67
Q

Macrophages vs T cells containing HIV

A

Can harbor viruses for much longer due to cytopathic resistance

68
Q

Major mechanism of CD4 T cell loss is

A

lytic HIV infection of cells, and cell during during viral replication

69
Q

Matrix protein of HIV

A

p17

70
Q

Microglial nodule

A

Brain equivalent of a granuloma

71
Q

Microscopically, involved areas of lung in P jiroveci infection demonstrate

A

intra-alveolar foamy, pink-staining exudate

72
Q

MOA of anti-HIV-1 protease inhibitor drugs

A

Prevent viral assembly by inhibiting formation of mature viral proteins

73
Q

Most common Candidiasis presentation

A

Superficial mucosal infection

74
Q

Most common disease-causing fungus

A

Candida albicans

75
Q

Most common extranodal site in late-stage AIDS of lymphoma

A

Brain –> Considered AIDS-defining condition

76
Q

Most common form of opportunistic CMV disease

A

CMV retinitis

77
Q

Most common neurologic dysfunction in AIDS

A

Progressive encephalopathy (AIDS dementia complex)

78
Q

Most common opportunistic infections other than P. jiroveci

A

Mucosal candidiasis, CMV, Herpes, M. Tuberculosis and atypical mycobacterium

79
Q

Most common secondary infection of CNS

A

Toxoplasmosis

80
Q

Most common viral opportunistic pathogen in AIDS

A

CMV

81
Q

Most HIV sequence variants cluster in parts of the genome encoding

A

envelop glycoproteins

82
Q

Most readily detectable HIV viral antigen

A

p24

83
Q

Most sexually transmitted cases of AIDS in US are due to

A

MSM sexual contacts

84
Q

Most virus particles are found where in relation to follicular dendritic cells

A

Surface of dendritic processes

85
Q

Non-“opportunistic” bacteral pathogens infecting lungs

A

S pneumoniae, S aureus, H influenzae and gram negative rods

86
Q

Nonprogressors remain asymptomatic for

A

10 years: stable CD and low levels virus in plamsa

87
Q

Normal amount of CD4

A

1000/cu mm

88
Q

Normal CD4/CD8 ratio

A

1 to 2

89
Q

Normal duration of clinical latency phase

A

7-10 years

90
Q

Nucleus of CMV-infected cell

A

W/in nucleus, large inclusion surrounded by clear halo (owl’s eye)

91
Q

Outer to Inner: p24, envelope, p17

A

Envelope, p17 matrix, p24 capsid

92
Q

P jiroveic infection in lung produces

A

Interstitial pneumonitis

93
Q

People with defective ___ are relatively resistant to developing AIDS

A

CCR5 receptor

94
Q

Percent of new AIDS cases attributable to MSM contact

A

<50

95
Q

Pneumocystis jiroveci infection is largely confined to

A

lung

96
Q

Pneumocystis pneumonia usually occurs at CD4 levels below ___

A

200

97
Q

Pneumonia caused by __ is presenting feature in many cases

A

P. jiroveci

98
Q

Predominant cell types in brain infected with HIV

A

Macrophages, Microglial cells

99
Q

Prominent intranuclear basophilic inclusions spanning half the nuclear diameter set off by clear halo

A

Owl’s eye –> CMV

100
Q

Property conferred by vpr gene

A

HIV-1 can infect and multiply in terminally diff, nondividing macrophages

101
Q

Pseudohyphae –> Budding yeast cells joined end to end at constrictions

A

C Albicans

102
Q

Qualitative defects in T cell function

A

Reduced antigen-induced t cell proliferation; impaired Th1 cytokine production; Abnormal intracellular signaling

103
Q

R5 use what as their coreceptor

A

CCR5: Macrophages and T Cells

104
Q

Reduces surface expression of CD4 and MHC on infected cells

A

Function of HIV nef gene

105
Q

Round to cup-shaped cysts in silver stain

A

P jiroveci infection

106
Q

Silver staining of tissue in P jiroveci infected lungs reveals

A

Round to cup shaped cysts, often with intracystic bodies but without budding, in the alveolar exudates

107
Q

Soap-bubble lesions

A

Cryptococcus gelatinous masses expanding the Virchow-Robin spaces

108
Q

Sore throat, myalgia, fever, rash, and sometimes aseptic meningitis

A

Acute phase

109
Q

Stains effectively highling Cryptococcus

A

India ink or Periodic acid-shiff

110
Q

Structure of HIV-1

A

Spherical, contains electron-dense, cone-shaped core surrounded by lipid envelope derived from host cell membrane

111
Q

Symptoms during clinical latency phase

A

Either asymptomatic or persistent lymphadenopathy, minor opportunistic infections (thrush, herpes)

112
Q

Symptoms of patients with >500 CD4 cells

A

generally none

113
Q

The immune response against HIV-1 is directed against

A

the viral envelope

114
Q

The initiation of proviral DNA transcription occurs only when

A

infected cell is activated by exposure to antigens or cytokines

115
Q

The progression of HIV infection in vivo is dependent on

A

nef gene

116
Q

The property of syncitia formation is confined to __ strain of HIV

A

X4

117
Q

Timeframe of Acute Phase

A

3-6 weeks after infection (50-70% of patients)

118
Q

Transition from acute to chronic phase is characterized by

A

Dissemination of virus, viremia, development of host immune response

119
Q

Tropism of R5 HIV

A

Macrophages and T Cells

120
Q

Tropism of X4 HIV

A

Just T cells

121
Q

Typical adult patient in US presents with

A

Fever, weight loss, diarrhea, lymphadenopathy, multiple opportunistic infections, secondary neoplasms

122
Q

Typically, AIDS patients present with

A

Fever of more than 1 month, fatigue, weight loss, diarrhea

123
Q

Unlike in Candida, ___ are not seen in Cryptococcus

A

Psuedohyphal or true hyphal forms

124
Q

Viral glycoproteins on HIV

A

gp120, gp41

125
Q

Viral load peak during primary infection (acute)

A

10 million/mL

126
Q

Virus is most likely carried into brain by

A

monocytes

127
Q

W/in nucleus, large inclusion surrounded by clear halo (owl’s eye)

A

Nucleus of CMV-infected cell

128
Q

What binds to CCR5 and CXCR4

A

gp120

129
Q

What does gp120 bind to

A

CCR5 (macrophages) and CXCR4 (T cells)

130
Q

What has accounted for approx 80% of deaths of AIDS patients

A

Opportunistic infections

131
Q

What level of CD4 is associated with severe immunosuppresion

A

<200

132
Q

What percent of patients have clinically evident neurologic dysfunction

A

40-60%

133
Q

What percent of patients have neurologic involved on autopsy

A

90%

134
Q

What reflects the onset of immune system decompensation

A

Persistent lymphadenopathy with significant constitutional symptoms

135
Q

Where are most HIV-infected macrophages found

A

Tissues, not peripheral blood

136
Q

Which level provides info about direction in which disease is progressing

A

Viral load

137
Q

With immunosuppresion, mycobacteria do not evoke

A

granuloma formation

138
Q

X4 use what as their coreceptor

A

CXCR4: T cells

Pathology 2 (9 decks)

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